CHRU Jean Minjoz, Service d’hépatologie et soins intensifs digestifs, 25000 Besançon
CHU Amiens-Picardie, Service d’hépato-gastroentérologie, 80054 Amiens Cedex 1
CHRU Jean Minjoz, Service de chirurgie digestive, 25000 Besançon
CHRU Jean Minjoz, Service d’urologie, 25000 Besançon
Refractory ascites (RA) is a frequent complication of liver cirrhosis. Its prognosis is poor with a 6-month transplantation-free survival (TFS) of only 50%. Liver transplantation (LT) represents the treatment of choice for RA but its access remains limited and the waiting time on LT list may be long for eligible patients. In selected patients, the placement of a TIPS (transjugular porto-systemic shunt) improves TFS and reduces the need for paracentesis. Iterative large volume paracentesis are the first-line treatment of RA but they are associated with a decrease in quality of life due to repeated hospitalizations. The alfapump® is an implantable device that can be recharged by induction. It comprises a pump implanted subcutaneously in the abdominal wall, connected to a catheter located in the peritoneal cavity and to another located in the bladder, thus allowing the transfer of ascites and its elimination by the urinary tract. The alfapump® is effective for reducing the need for paracentesis and for improving quality of life and nutritional status. However, no impact on survival has been demonstrated to date. The most frequent complications are renal failure, bacterial infections and dysfunction of the device. In the absence of absolute contraindication (i.e. loculated ascites, urinary outflow tract obstruction, contraindication to general anaesthesia, poor short-term prognosis), alfapump® is an alternative treatment to be considered for patients not eligible for TIPS, listed or not for a liver transplantation.